Connect Request for Utility Services

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Please correct the fields below:

1
First Name
 *
2
Last Name
 *
3
Business Name (if applicable)
4
Date Service to Begin:
 *
5
Service Address
 *
6
Billing Address (if different than service address)
Billing Address (if different than service address)
7
Phone Number
 *
8
Alternate Phone Number
9
Are you the owner of the property?
 *
Are you the owner of the property?
10
Service Type?
 *
Service Type?
11
Email Address
12
Do you currently or have you ever had utilities with the City of Yankton before?
Do you currently or have you ever had utilities with the City of Yankton before?
13
Current Address
 *
14
Other names used?
15
If a commercial account, do you request City garbage services?
If a commercial account, do you request City garbage services?
16
Do you have a separate sprinkler meter?
Do you have a separate sprinkler meter?
17

CONTRACT 

I, the undersigned customer, do hereby make application to the City of Yankton Finance Department for services at the address stated above and commencing on the date shown above and agree to pay for said services as bills are rendered therefore in accordance with the rates, rules and regulations as prescribed by the Board of City Commissioners and in effect at the time of delivery.

18
Printed Signature
 *
19
Date
 *
20
Attach a copy of your drivers license here:
 *

*A non-refundable service charge of $30.00 is due upon this application.

**No service will be granted to customers with a delinquent account from a prior residence or unpaid deposit if required.

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